Insurer's Wellness Effort Scores Good 5-Year Return

Healthy Blue Living in Michigan lets employers and members reap the benefits of lifestyle improvement

Frank Diamond

When Blue Care Network, the affiliated HMO of Blue Cross Blue Shield of Michigan, launched its wellness program five years ago, company officials were momentarily surprised by how quickly the effort grew, says Marc Keshishian, MD, Blue Care Network’s senior vice president and chief medical officer.

“This was very original in the state of Michigan — probably in the whole country — in that there were so many components,” says Keshishian. The program targets tobacco use, weight, blood pressure, cholesterol, depression, and blood sugar. Employers paid extra for this program, and “in order for members to receive enhanced benefits, they had to work with their doctors on these six components,” he says.

Influx of members

Shortly after the launch, 15,000 members joined. Within a year, there were 50,000. Enrollment in both products — Healthy Blue Living and Healthy Blue Living Rewards — stands at about 111,000 in more than 800 physician groups. Healthy Blue Living, launched Oct. 1, 2006, is the first HMO-backed wellness plan in Michigan to offer incentives, company officials say. Healthy Blue Living Rewards, launched just last October, offers three tiers of incentives based on whether participants achieve specified health measurement goals.

More than 70 percent of participants have reached lifestyle goals that guarantee them reductions in copayments and deductibles. Health insurance plans wanting to replicate Blue Cross Blue Shield of Michigan’s success would do well to rely on input from their own clinical executives, says Keshishian. “This plan was driven by both the marketing department and the medical department. The medical department felt very strongly that we needed to be involved and to ensure that we had the right criteria, to ensure that we have the right diseases. And to ensure we have the right motivation both from the physician and the member side to have people get more control of their health.”

“We really try to encourage members to work with their physicians to control diseases that require medications,” says Marc Keshishian, MD, CMO of Blue Care Network.

The most difficult condition to control is obesity. “In October 2010 we added a new component to the program: We provided our members and their spouses with pedometers if they were overweight. They had to walk an average of 5,000 steps a day to remain in enhance benefits. They downloaded that information into the computer. Or they had to join Weight Watchers and attend 11 out of 13 sessions. You have to work with your doctor and with the health plan if you want to receive enhanced benefits.”

Healthy Blue Living has two benefit levels members can qualify for, based on whether they meet the plan’s initial requirements, such as having a BMI below 30, says Keshishian.

Standard benefits: “Members earn the standard benefit level when they don’t meet the plan’s health requirements. This level of benefits provides solid health care coverage, but the member has higher out-of-pocket costs.”

Enhanced benefits: “Members earn enhanced benefits when they meet the health measurement requirements and/or are working to improve their health. This level of benefits provides the same great coverage, but with much lower out-of-pocket costs for the members.”

Cause unknown

Despite technological advances, experts still struggle to pinpoint the exact cause of obesity, says Keshishian. “What we do know is that if people become fit through walking and other exercise, they’ll have lower health care costs. But it is very difficult for many people to get down to a BMI of less than 30.”

Employers and insurers just want to see the effort. “We’ve had many people who have started walking and have expressed thanks to the health plan. They said, I used to think I walk a lot, but now I’m walking a whole lot more than I ever did in the past because I’m counting the number of steps and I have this pedometer on me and I know how many steps I’m walking and I’m pushing it more. For many people it’s become a competition. People are competing against their friends and others to see who can mark the most steps.”

Healthy Blue Living includes a robust pharmacy component to deal with hypertension, diabetes, and cholesterol. “If the blood pressure is not controlled, we expect members to go back and see their doctors regularly,” says Keshishian. “Doctors can say on the form that they want the member to be seen again in three months. If members don’t show up, they get moved down to standard benefits, which are good benefits, but not so good as the enhanced benefits. So therefore we really try to encourage members to work with their physicians to control diseases that require medications.”

Employers save

On average, businesses save 9 percent when they select Healthy Blue Living over the traditional HMO product. They save 14 percent with Healthy Blue Living Rewards.

Members can save as much as $2,000 a year, says Keshishian. “If somebody uses a lot of health services, if he’s in the enhanced versus the standard, he’ll be saving a significant amount of money.”

Even relatively healthy members benefit in Healthy Blue Living because the emergency room copayment is less than it is under traditional benefits. “And you never know when you’re going to have to use the ER.” Bottom line? “We want people to take charge of their health and be responsible for their health,” says Keshishian. It seems to be working.

Employers like what they see

Over 90 Michigan businesses have been with Healthy Blue Living (or Healthy Blue Living Rewards, launched last year) since the original product was launched in October 2006. It’s proven to be a cost-cutter, says Bryan Van Doornik, the controller at Pat Milliken Ford, one of the biggest Ford dealers in the country. “We liked it because it allowed us to offer an affordable, quality health care plan to our employees without drastically increasing health care costs on our end.”

Blue Cross Blue Shield of Michigan looks for ways to improve the program, say company officials. For instance, last year the insurer added new features that include:

Conducting continine testing to check for nicotine use instead of looking only at smoking to help members quit.

Adding a weight management requirement for members with a BMI of 30 or more. They are given the choice of joining either Weight Watches or a pedometer-based walking program.

Screening for depression rather than alcoholism because, company officials say, depression is the leading cause of disability worldwide.

Managed Care's Prospects in the Health Reform Era

Princeton’s Uwe Reinhardt, PhD, renowned health care economist, sits down with Managing Editor Frank Diamond to discuss the economic effects of the Affordable Care Act, wellness programs, and the state of health care in the United States in general.